心脏外科肺动脉高压患者围手术期一氧化氮的吸入治疗  

Perioperative nitric oxide inhalation therapy for open heart surgery patients with pulmonary hypertension

作　　者：张翔宇[1] 杨自建[1] 

机构地区：[1]上海同济大学附属上海市第十人民医院SICU,200072

出　　处：《中国危重病急救医学》2007年第9期546-548,共3页Chinese Critical Care Medicine

摘　　要：目的探讨一氧化氮（NO）吸入治疗对合并肺动脉高压心脏外科围手术期患者的有效性与安全性。方法应用Servo300A呼吸机或AeronoxNO释放与监测仪,对合并肺动脉高压且临床常规治疗效果不理想的27例成人和1例房间隔缺损修补术患儿进行围手术期NO吸入治疗,NO开始剂量（5～10）×10^-6,然后根据病情可缓慢升高至20×10^-6。于治疗前后监测患者的肺动脉压（PAP）、动脉压（AP）、肺血管阻力（PVR）和氧合指数（PaO2/FiO2）。NO吸入治疗的有效标准为治疗开始后1h内AP/PAP改善20%以上,或PaO2/FiO2改善20%以上。NO吸入治疗1.5h后无效者终止该方法。结果成人患者NO吸入治疗有效率为77.8%（21/27例）,治疗持续时间为12～96h,平均（32.6±10.3）h。1例房间隔缺损合并中度肺动脉高压患儿在房间隔缺损修补术后,肺动脉高压加重,合并严重的低氧血症〔PaO2/FiO2为40mmHg（1mmHg=0.133kPa）,吸入氧浓度（FiO2）为1.00〕,经NO吸入等综合治疗后效果明显,4d后撤离呼吸机。治疗中与治疗后,在患者与工作人员中未发现不良事件。结论NO吸入治疗对心脏外科合并肺动脉高压围手术期病情加重者治疗有效,值得进一步临床探索。Objective To investigate effectiveness and safety of perioperative nitric oxide （NO） inhalation therapy for open heart surgery patients with pulmonary hypertension. Methods Servo 300A and Pulmonox Aeronox were used for NO delivery and monitoring. NO was used perioperatively in 27 adult and 1 pediatric open heart surgery patients with pulmonary hypertension which were not effectively relieved by conventional treatment. At the beginning of NO inhalation therapy, the dose of NO was （5 - 10） ×10^-6, and mildly elevated to 20 ×10^-6. Pulmonary arterial pressure （PAP）, arterial pressure （AP）, pulmonary vascular resistance （PVR） and oxygenation index （PaO2/FiO2） of patients were monitored before and after treatment. Criterion for NO responsiveness was： AP/PAP or PaO2/FiO2 improved more than 20% within 1 hour. NO inhalation therapy was discontinued if there was no response within 1.5 hours. Results Responsive rate in these adult patients was 77.8% （21/27 cases）. Duration of NO therapy was 12 - 96 （32.6±10. 3） hours. One 4 - year - old atrial septal defect child with medium severity of pulmonary artery hypertension showed deterioration of pulmonary hypertension with serious hypoxemia （PaO2/FiO2 40 mm Hg （1 mm Hg=0. 133 kPa）, fractional concentration of inspired oxygen （FiO2） was 1. 003 post operatively. NO inhalation therapy showed a very marked response and effect. The child was weaned from mechanical ventilation in four days. No adverse event was detected in patients and caregivers during and after NO inhalation therapy. Conclusion NO inhalation therapy is effective in cardiac surgery patients with deteriorating pulmonary artery hypertension perioperatively. Further clinical investigation is urgently needed for promoting it to become a clinical routinely available therapy.

关 键 词：一氧化氮 吸入治疗 肺动脉高压 

分 类 号：R686[医药卫生—骨科学]